Org A No Phosphate Poisoning

Organophosphate poisoning • Bind to acetylcholinestrase enzyme • S/S: Nicotinic: muscle weakness, fasciculation Muscarinic: DUMBELS syndrome D→ diaphoresis, diarrhea U→ urination M→ miosis B→ bradycardia, bronchorrhea, bronchospasm E→ Emisis L→ lacremation S→ salivation A→ salivation, aspiration B→ Respiratory failure, , bronchorrhea, bronchospasm C→ hypotension, bradycardia, shock, arrhythmias, ↑QT(poor prognosis) D→ Avoid aminoglycosids ABx M→ lytes abnormalities, acidosis, dehydration GI→ N&V, diarrhea

CNS→ ↓LOC, Sz, weakness • Lab→ CBC, Lytes, BUN, creat, Mg, Ca, Phos, toxicology screen (blood and urine), cholinesterase level • Consider CT head and X-rays • Contact poison center if suspect other poisoning • Mx: o ABC, apply monitors o IV, fluid bolus, Atropine, 2-PAM(pralidoxime) for nicotinic effect, consider other inotropic support, BNZ for seizure o Expose and wash o NG suction, activated charcoal 1-2g/kg o Atropine 1mg q10min, Peds 20ug/kg q 10 min, until you see signs of atropinization (↑HR, ↓ secretion, dilated pupils, dry mouth) o 2-PAM is a cholinesterase reactivator, for adult 1-2g IV over 15-30 min, Peds 25mg/kg also over 15-30 min, or gtt up to 500mg/hr